From the Research
Diltiazem should be tapered gradually over a period of time, rather than stopped abruptly, to minimize the risk of rebound symptoms. The most recent and highest quality study on tapering medications, although not specifically on diltiazem, suggests a gradual tapering process to minimize the risk of relapse or rebound symptoms 1.
Key Considerations
- A typical taper involves reducing the dose by approximately 25-30% every 2-3 days, but this can be adjusted based on individual patient factors.
- The specific taper schedule should be individualized based on the patient's initial dose, duration of therapy, and clinical condition.
- Abrupt discontinuation of diltiazem can lead to rebound angina, hypertension, or tachycardia due to upregulation of calcium channels during chronic therapy.
Monitoring and Adjustments
- Patients should be monitored for signs of rebound symptoms during the taper period, including chest pain, elevated blood pressure, or increased heart rate.
- If these occur, slowing the taper or temporarily returning to a higher dose may be necessary.
Clinical Context
- The studies provided do not specifically address the tapering of diltiazem, but they do provide information on the effects of diltiazem on blood pressure and heart rate 2, 3, 4, 5.
- However, the general principle of gradual tapering to minimize rebound symptoms can be applied to diltiazem, as it is a calcium channel blocker that can cause upregulation of calcium channels during chronic therapy.